Provider Demographics
NPI:1891233060
Name:BARRETT, JOHN TODD (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:TODD
Last Name:BARRETT
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2624
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39158-2624
Mailing Address - Country:US
Mailing Address - Phone:601-859-4342
Mailing Address - Fax:
Practice Address - Street 1:10 CANEBRAKE BLVD STE 110-018
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-2211
Practice Address - Country:US
Practice Address - Phone:601-859-4342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-07
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR7595183500000X
TN7754183500000X
MSE7804183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist